HomeMy WebLinkAbout91-1797
STATE OF FLORIDA
City of Zephyrhills
PASCO COUNTY ....0 /J
BUILDING DEPARTMENT Permit.A · 1797 ;('j
/0 1-,-:37 _ 1-813-788-6611 9-.?- ';1_ 9/
Type~f Permit J- ';IJ,J.S .;2~.;1. ..so / 07, S?!. ~ 6,v.., 74' .,1/. 7~-
C8UILD~E:ECTR~ rPLUM8~ECHANIC~1},,;ti; ~ /"i'l3, 7.s-
- ~~:::~ ~ ~---~---'e:l-/,."/Jt,~ ~?~'. c)i)
Property Owners Nam~ . ()~;f/j;J u",k
Job Address: 6---s 1.;2 ~~7f' _ _ _
Legal Description: Sub.Div.
Lot
Blk.
ZoningCI: .2 -.2(,-;)../ - : A - 0 - /
Description of Work cjf~dl X/C<"(f n;;tA':]1 0- ~ 1>---4/A-J~-
.':t~A~~;'" ~_n7' ,~
Energy Code Readout: ..s t.,
:10-; J d. ,-/, 6 ~
,
yU"nJt.l /!9f/Aff7
OCCUPATIONAL LICENSE #,3:1. 'I
~Pif
I
Fee: c2., /7 J" ~ ~ -<;9- 9/ ?'Jl
SIGNAT~R~~ ;]~
COMPANY ~ l.'~
ADDRESS (jOt 3o;;r ~'fc,!( l-a-f;ek-, J j:/ If
TELEPHONE #;:-1 5 - 6' ....{<f -- 0 4 r-6
Complete Plans, Specifications and Fee Must Accompany Application
Estimated Cost: t-S .3 ~ h? ~. 00
All work shal! be performed in accordance
with the above and all City Codes
and Ordinances.
t.J,
joy'
p
SLB Tp.Serv.
Pre SLB u;rUb Set c;, Rough In ;fvjj(4( /f../l-:!f( Breakers
Lintelf, Water -g;;;];f(]eter Ca~ Ducts Insl.
CFRM. N-fMJ.,.-II_Il.qf /J.~ Sewer 10.-1-, I Canst. Pole '...~6 -qi" comp.ressor
Insul.CL Final Pool Final
. WL . ;) /I-15~ I .d . Pre-Meter fl- ftJ - en
JI--IJ~/ gA ~ Fnal ~ ..,,--" 1
DDveway . /ldJr1' f~J 1.1-~ 4 ,
foorUplliJ( N.t./-'iJ {3..:J (~rrt uml1Hl. SLA -- o."l{
Relnspectlons: When extra inspection trips are necessary due to anyone of the following reasons, a charge of ten (SIO.OO)
dollars shall be made for each trip.
(a) Wrong Address
(b) Condemned work resulting from faulty construction
(c) Repairs or corrections not made when inspection called for
(d) Work not ready for inspection when called.
The payment of reinspection fees shall be made before any further permits will be issued to the person owning same.
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APPLICATION FOR PEIDlIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
Cd~~.-o
APPLICANT
PHONE
ADDRESS
OWNER r:I/1~-</
JOB LOCATION {;Sf ~
~lLl!lJ /1LJ!
LOT SIZE
x
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
PARCEL 1. D. ~F :J".;; b - ;;1-(
BLOCK
SUBDIVISION
WORK PROPOSED: ~New Construction ____Addition --^lteration ____Repair ____Install
____Sign/Temp. ____Sign _Hove ____Demolish
PROPOSED USE: ____Single Family ~/F ____t~ of Units ,._M/H
V<::ommercial ____Indust. ____Swim. Pool Other
____Restaurant & Health Department Approval
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORl'1S.**
**COPY OF CONTRACT REQUIRED.
V/ BUILDING
pERMITS REOUESTED
$ 3'3;).., &76'. c,...-u Valuation of Total Construction
,
~ELECTRICAL
~MECHANICAL
VpLUMBING
AMP Service
Florida Power Corp.
_W.R.E.C.
$
Valuation of Mechanical Installation
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block
____Frame ____Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
BUILDER /3 ~ J.
Signature l J()J\.....<-.
,
********1,******************1C,~*~1C::'_/J-l' ~
JY/ CONTRACTOR SECTION ~':''VI ~
a-1YLQ . Company E..J. IYI . c..o. f
r .
;:J State Cert. or Regist. 1F
_ o.~..r-. City License ReRistration " 3;;L '-I
** ******************************~K~X*U***
company)2,rL17Ti"{) ELE{'TJfJC.~, -TNC
State Cert. or Regist. iF Rf?,0'CD9Lf69
City License Regis.tration iF ...l.;;t..2..
******************************************
Signature
uP ~'il
. Company' 'ox 0 _ I ....y~~
~l ~ ~ State Cert. or Regist. 1.!
I '. ~ City License Registration iF /3 Y
. *** *************************************
j
PLUMBER
MECHANICAl.
"-;y ()
Signature 'r~
companyT6. 'I/o f/' tilV' Co ~'1 ci ,fro VI fnJ
0~ ..-,........ State Cert. or Regist. !I~A-C or.j("f ~.5
~fT--- City License Registration 11 /0"1
******************************************
OTHER
Signature
Company
State Cert. or Regist. 0
City License Registration 0
APPLICATION APPROVED BY
-~*********~**************************
()At.A"~. pA ~ .
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
.
The undersigned understands that this perlit lay be subject to "deed restrictions" which ~ay be lore restr.ictive than City
regulations. The undersigned aSSUles responsibility:for co.pliance with any applicable deed restrictions.
. ,
8. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake Mork, they lay be required to be licensed in accordance with
state and local regulations. If the contractor il not licensed as required by laM, both the owner and contractor lay be
cited for a tisdeleanor violation under state laM. If the owner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (813)
788-bbll.
Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractorls) sign portions of the
'Contractor Sections" of this application for Mhich they Mill be responsible. If you, as the owner sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to permitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D.
CONSTRUCTION LIEN LAW
(CHAPTER 713~ FLORIDA STATUTES, AS AMENDED>
1 certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien LaM - HOleowner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consumer Affairs. If the applicant is sOle{.ne other than the
'owner', I certify that I have obtained a. copy of the above described document and promise in good faith to deliver it to the
'owner' prior to cO.lencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work Mill be done in cOlpliance Mith all
applicable laws regulating construction, zoning, and land developDent.
Application is hereby lade to obtain a perlit to do Mork and install~tion as indicated. I certify that no work or
installation has cOllenced prior to issuance of a perlit and that all work Mill be performed to meet standards of all laws
regulating construction, City cod~s, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies ~ay apply'to the intended Murk, and that it is
IY responsibility to identify what actions I must take to be in cOlllplianc~. Such agencies include bill ~le Hc.l lil!ited to:
. ".."..
. Depart.ent of Environmental ReQulation - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands,
Water/Wastewater Treatment
. Southwest Florida Water' ManaQelent District - Wells; Cypress Bayheads, Wetland Areas, Altering Watercourses
. ArlY Corps af EnQineers - Seawalls, Docks, Navigable Waterways
. ~epartlent of Health ~ Rehabilitative Services, Environmental Health Unit - Wells, Wastewater Tr~at~en~. Septic Tanks
. US Environmental Protection AQenct - Asbestos abatement
I also certify that, if filllat~rial is to be used in Flc.od Zone "A" or 'A,etc.', it is understc,c,d th~t a drainage plan
addressing a 'coapensating volule" will be sublitted Mhich is prepared by a professional engineer regist~ied in the state of
Florida prior to perlit issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official fro~ thereafter
requiring a correction of errors in plans; construction, or violations of any code. Every permit iSSlled ~hall becole invalid
unless the work authorized by such permit is coalllenced Mithin six sonths of issuance, or if wOI'k authol lied by the perlit is
suspended or abandoned for a period "of six lonths after the ti,e the work is commenced. Dne 90 day e:IE~sioll of tile, aay be
allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection must be logged during each six month period, or the project will be considered dba\Jdoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE
DO NOT NEED TO RECORD AND POST A "NOTI~E OF COMMENCEMENr".
{/L L.C -r-l/bo-fff V}r 0 r-.3
SIGNATURELJ.~~-~/:~
OUNTRACTOR ~?f~------
DATE___S~_d_S1-[LrLL__---
NOTARY T \/}!J r,
CONTRA TOR - _~flal~~~-----
SIGNATURE
----------------------------------
OWNER OR AGENT
DATE_______________________________________
NOTARY AS TO
OWNER OR AGENT
MY COMMISSION EXPIRES______________________
MY
-------~ - ----.---,-...--
-----------------------------
NOT ARY PUBLIC. STATE OF FLORiDA
MY COMMISSION EXI'IRES: JAN. 28. 19911
BONDED THRU NOTARY PUBLIC UNDERWR1'tER8J.
TRANSMITTAL
TO: City of Zephyrhills
5335 Eighth Street
Zephyrhills, Florida 33540
DATE: September 23, 1991 I JOB NO.: 2011-28.00
ATTENTION: Roy Burnside
RE: Amoco Split Second Station No. 60656
N.E. Corner of US 301/CR 54E
Pasco County, Florida
FAX
OVERNIGHT
X SAME DAY DELIVERY
Hand
1 ST CLASS MAIL
PICK-UP
_ No. of Pages including this page
WE ARE SENDING YOU X ATTACHED
UNDER SEPARATE COVER
QUANTITY DATE / DESCRIPTION
1 09/20/91 I v Copy of State of Florida HRS Approval for referenced project.
1 8/22/91 r/ V Copy of FDOT Drainage Connection Approval for referenced project.
1 9/23/91 v' V Copy of FDOT Connection Application Approval for referenced project.
1 9/16/91 0 Copy of SWFWMD Approval.
1 8/08/91 Y Vcopy of Pasco Co. Driveway Permit. -------- -- ~~._.~._. --~'-
1 9/17/91 t/ HRS Pasco Co. Public Health Unit APProv~, (One set of Site Drawings). )
V ,;,. '"""-
1 ..- Copy of Warranty Deed.
1 9/03/91 v/ Amoco Check No. 205947 in the amount of $36,913.67 for Transportation Impact
Fees.
THESE ARE TRANSMITTED as checked below:
~ For Approval
X For your use
_ As requested
For review and comments
REMARKS:
FAX
OVERNIGHT
SAME DAY DELIVERY
SIGNE .
Wilson R. Abreu
'~~P~'liA-I~NGINEERI~~i15~anager
COpy TO:
_ No. of Pages including this page
O,,/! En1f1~~retlm:Jf fimlfmJteCi91 Jr~pgJotify us at once.
102 W Whiting Street Su!le 501 Tampa FlOrida 33602 813-22i-0048 FAX 8:3-224-9728
:[
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.
FORM lIOOA.91
Non.Ruld.nUII Buildings
PROJECT NAME:
ADDRESS:
CITY. ZIP CODE:
BUILDER: -7
OWNER:
FLORIDA ENERGY EFFICIENCY CODE FOR BUilDING CONSTRUCTION
SECTION 8 · SIMPLIFIED ANNUAL ENERGY METHOD
ADMINISTERED BY THE DEPARTMENT OF COMMUNITY AFFAIRS
Al _ ClIMAL ZONES
ZONE 4
BUilt ~a ClASSIFICA-ION(S): ZM-1
BUilt ~a PERMIT NO. J? 9' ?
PERM TINa OFFICE: .' f.
JURISICTION NO.: 6, ~ ()
& County Rd 54
BUILDING INFORMATION
WALLS ROOF/CEILI~G FLOC RS DOORS GLASS
TYPE U AREA TYPE U AREA TYPE U AREA TYPE U AREA TYPE U AREA
Contrete (CBS) . Under allic Slab-oni,lrade WOOd Single wall
Wood frame Single Assembly . lib ,-sY/I] Aaised Wood l.4elal Double. wall l~~ 40\1
Metal frame Other Aaised concrete Insulaled Single. fool .:~ ~?Ll
Insulation A.value Insulation A-value Insulation A.value Other Double. fool
SYSTEMS INFORMATION
AIR CONDITIONER HE T1NG SYSTEM Hm WATFR
TYPE EFFICIENCY TONS TYPE EFFICIENCY BTU/H TYPE
Unitary & Heat Pump Central & Heat Pump ElectriC
<65,000 Btulh SEER < 65.000 Btu / h HSPF ReSistance ~
,,65.000 Blulh ~.t> EER - IPLV ~ ~ 65.000 Blu / h -:Dr COP 100,000 Oed Heal Pump 0
-
Water Cooled - EER - IPLV - Water cooled COP Gas
Evaporatively Cooled EER - - Nalura: 0
- - Evaporatively cooled COP 0
-. - LPG
PTAC - EER - Electric resistance COP 0
- -- Oil
Chillers - COP - IPLV - GaS/Oil (circle one) HRU 0
Other; . < 225.000/300.000 BIl!' AFUE Olher
- - --~- .._~
LIGHTING KW: ~ 225.000/300.000 BI EI
- -.
COMPONENTS
PRESCRIPTIVE MEASURES (Must be let or ex(
SECTi)N REOUIRE v1ENTS
CHECK
X
Windows
poors
JointS/Cracks
Aeheat
Ventilation
HVAC Efficiency
Transpon Energy
Balancin
HVAC Controls
HV AC DudS
5024
502.4
502.4
503.3
503.4
503.4
503.5
503.6
503.7
503.8
503.9
503.10
50311
i,. 504.2
Piping Insulation
Water Heaters
~IJI/'i
': ::'
Swimming Pools
& Spas
Hot Water Pipe
Insulation
Waler Fix1ures
504 .2
504.4
504.5
Lighting.
505.1
SECTION 8 COMPLIANCE
Budget (Table 8-1): 58
Building MBTU/SF: .bb
Conditioned sq. It: 3\1/0
.ded by all buildings.)
Maximum of .37 elm per linear loot of operable! Ish crack.
Maximum of 1.25 elm per square foot of door aru"
To be caulked. gasketed, weatherstripped or otherwise sea!, .1. ____
Supply air restrided to set cold/hot deck temperature to me' load ot worst case zone teslstance rohoat prohibllod
Supplied with readily accessible switch for shut'off and/or vc 'Ie reduction when ventl,ation is not required.
Minimum efficiencies. Heating: Tables 5.4.5-5 & 5-6. Coolir -abies 5-7A. 5-7B, 5-8 & 5-9.
Minimum of 8.0.
Provide means for balancin HVAC air s stem & water distrrbullon system.
Separate readily accessible manual or automatic thermostat for each system
Air ducts. fittings, mechanical equipment and plenum chambers shall be mechanically attached, sea1r.d
insulated and installed in accordance with the criteCla of sections 503.8. 503 9 and 503.10
X
In accordance with Table 5-10.
Automatic eledric storage water heaters s120
s 75,000 Btuth shall meet performance minim"
meet minimums in Table 11-1 of Standard AS.
Spas & heated pools must have covers. Non.,
Gas spa & pool heaters must have minimum It
Piping heat loss is limited to 17.5 Btu/h linear I,
Ins and. gas & oil-fired star Je water
In Table 5- 11. Larger Size water he
Ifler 1/1/92.
mmercial pools IT 'have p '1P timer
rmal efficiency of
, of pipe for reCllC" Itrng sy~ ms (see
'aters
'Jrs shall
Water flow restrided to maximum of 3 gpm at i psig; toilets maximum 3.5 g on flush
PubliC lavatory fiX1Lre maximum flow of .5 gpm )[ .5 gallon if has selt-closlng live.
Minimum Ballast E'Iicacy Fadors are listed in 1 able 5-14.
I N/A
--j NA
'iiOs:;"--l- ~/A
I
SECTION" COMPLIANCE
Computer program used'
Sect ion 5 Budge!:
Section 4 Total:
I ,.reby CMlfy t~=r>d . h'ltealtons CNer~ 'M r..alculalloe "" ,n, co" mPl1;Jn, ",.0
P~:;:::D':~El-!~.i~L/~-:_ _ _....._._DATf 1 L / ~/
I hereby cort1ty tHat thiS bulldl(')Q ,'; wllh tho FlOrida En9rQV>dl~
OWNER/AGENT: ~_____._.__.__ DA
>vorod by Ihls calculi11l0n inchc..1lO' ompll,lnce WIth ttlr:
Jet Ion I complelOO, thIS buik:hn~.....: spoctod lor
8. F S
Measures
Compliance with Section 6 was demonstrated by a Prescriptive
methodology or by Dual Calculation
~ 807.2 Supermarkets
807.3 Restaurants
807.4 Kitchens
B 809.2 Basic Features
809.3 Dual Calculation
B et
rrUILDING OFFICIA .
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FLORIDA ENE ::tGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
SECT, ON 8 · SIMPLIFIED ANNUAL ENERGY METHOD
ADM NISTERED BY THE DEPARTMENT OF COMMUNITY AFFAIRS
TYPE
WALLS
U
.08
Corn: rete (CBS)
Wood frame
lolelal frame
Insulation A.value
AREA
22P.7
ALL Cl MATE ZONES
Z NE: 4
BUILDING CLASSIFICATION S :
BUILDING PE RMIT NO.: 7
PERMITIING Of:FICE:
JUF ISDlcrIOI~ NO.:
. 33~-C/ ()
BUILDING INFORMATION
F o-nF/CEILlNGFLOO RS
TYPE U AREA TYPE U
D )ORS
TYPE U AREA
Wood
Metal
Insulated
Other
GLAS
TYPE U . AREA
Single. wall
Double. wall .Lj.:J OUL
Single, roor . I 'ILf
Double. roof
Under attic
Single Assembly
Other:
Insulation A.value
Slab-onilrade
~aised Wood
R.ised concrete
. ,sulation A-value
AREA
j~/U
.Ub J()/O
SYSTEI S INFORMATION
AIR CONDITIONER HEATING SYSTEM IoInTNATER
TYPE EFFICIENCY T()N~ TYPE EFFICIENCY BTU/H TYPE
Unhary & Heat Purr ~ -
Central & Heat Pump Electric ~
<65.000 Btulh --a:oSEER IPLV 12.5 .. <: 65.000 Blu /I z:-g- HSPF Aesistance
~s.ooo Btulh ~EER - ~ 65.000 Btu' II ~COP 62,877 Oed. Heat Pump 0
Water CooI9d - EER - IPLV - __ COP Gas
\ Iter cooled - NaMal 0
Evaporatlvely Cooled EER
- - f aporalively cooled _ _ COP 0
- LPG
PTAC - EER - Elelllic resistance _ _ COP 0
- Oil
Chillers - COP - IPLV - Gas/Oil (circle one) HRU 0
Other: < 225.000/300.000 Blu/h __. AFUE Other
-
LIGHTING KW: ~ 225.000 /300.000 Btu I h __Et ..
-
COMPONENTS
Windows
poors
Joints/Cracks
Reheat
Ventilation
HVAC Efficiency
Transport Energy
Balancin
HVAC Controls
HVAC Ducts
Piping Insulation
Water Heaters
Swimming Pools
& Spas
Hot Water Pipe
Insulation
Water Fixtures
Lighting
PRESCRIPTIVE MEASURES (Must be met or exce;}ded by all buildings.)
SECTION REQUIREMENTS
502.4
502.4
502.4
503.3
503.4
503.4
503.5
503.6
503.7
503.8
503.9
503.10
503.11
504.2
504.2
504.4
504.5
505.1
SECTION a COMPLlANCFs6
Budget (Table 8-1):
Building MBTU/SF: 55.9
Conditioned SQ. 11.: :\Q70
Maximum of .37 elm per linear loot 01 operable sash crack.
Maximum 01 1.25 elm per square loot of door area.
To be caulked. ga',eted, weatherstripped or otherwise sealee
Supply air restrictE I to set coldlhot deck temperature to meet Id of worst case zone. Resistance reheat prohibited.
. Supplied with reae y accessible switch for shl .t-off ard/or VOIL a reduction when ventilation is not required.
Minimum efficienc; Is.Heating: Tables 5-4, 5. ; & 5.6 Cooling: Tables 5-7A. 5-7B. 5-8 & 5.9.
Minimum of 8.0.
Provide means for balancln HVAC air stem & wa: lr distribution system.
Separate readily accessible manual or automatic the mostat for each system.
Air ducts. finings. mechanical equipment and plenun chambers shall be mechanically attached, sealed.
Insulated and installed in accordance with the enteri.: of seC1ions 503.8.503.9 and 503.10.
In accordance with Tablg 5-10.
Automatic electric storage water heaters s.120 gallons and gas & oil-fired storage water heaters
s. 75.000 Btulh sho" meet perfonnance minimums in Table 5-11. Larger sized water heaters shall
meet minimums ir fable 11-1 of Standard RS-9 after 1/1/92.
Spas & heated p< Is must have covers. Non-commercial pools must have pump time
Gas spa & pool h lters must have minimum thermal efficiency 01 78%.
Piping heat loss i! limited to 17.5 Btulh linear loot of pipe tor recirculating systems (see ,ble 5.12).
N/A
N/A
Water flow restricted to maximum of 3 gpm at 80 pslg; toilets maximum 3.5 gallon flush.
Public lavatory fixture maximum flow of.5 gpm or.5 gallon if has se~-closing valve.
Minimum Ballast Efficacy Factors are list, d in Table 5-1 J
x
SECTION 4 COMPLIANCE
Computer program used: __
Section 5 Budget
Section 4 Total:
Measures
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with<< F"
"PARED BY.
<>by certffy th.
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Re Il8W 01 pi< s and specIIlCations covel1ld by this calculation IndICates compliance whh the
Flurida Ene.. Code. Belore const 'On is pleted. this building will... i ed lor
compliance In ac:cor<<"nce wtlh 5 , F.S.
BUILDING OFFI
DATE
Compliance with Section 8 was demonstrated by a Prescriptive
methodology or by Dual Calculation:
~ 807.2 Supermarkets
807.3 Restaurants
807.4 Kitchens
B 809.2 Basie Features
809.3 Dual Calculation
Bu et
8-65
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ZEPHYRHILLS FIRE DEPARTMENT
Zephyrhills, Florida 33540
38410 6th Avenue
(813) 782-8184
FINAL BUILDING INSPECTION
Fire Chief
NilIiam T. Fenton
Assistant Chief
Robert Hartwig
OCCUPANCY: ./j~:nl( (J ~'i 1/ {--("
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DATE:
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BUSINESS PHONE: /,1 (,..~ '7
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OWNE MANA ER: /,LI(.' )(.. I -I I 1/";" '.
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This huilding has heen inspected by the Zephyrhills
Fire Department under the codes and regulations of the
NFPA Minimum Standards and other local fire safety codes.
r-
./ APPROVED
NOT APPROVED
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NOTICE
OF
RESOURCE RECOVERY ASSESSMENT FORM
APPLICANT/OWNER
PERMIT II / 7 9 7
DATE /J- - /..3 -- 7/
11
O/1"dr7~" -+b: ~"/Jy,dl
COUNTY PARCEL II c2 - :J- t, -;2/ - / A- _ (] _ /
5{/J/' 8LJ
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USE/CODE DESCRIPTION 1~~~/GcA~
~~<J 4ti-,,~ - d:L~ - ~ ~A~
LOCATION ~ --.5 '- / cJ
RESIDENTIAL
NON-RESIDENTIAL
ti UNITS
GROSS SQ. IT. (GSF) Lj 7' 9 /
RATE/ERU=$50.00 X O.96*/YEAR OR $O.1315/DAY ERU ASSIGN 1/
ASSESSMENT = (II UNITS)X($0.1315)X(NO OF DAYS) ASSESSMENT=(GSF)X(ERU)X(O.1315)X(NO DAYS)
100
$
III 7 &7
TOTAL FEE = $
TOTAL FEE
PREPARED BY
d1(~L( //
/ .
/ht.r-;/lit'1 tf
* DISCOUNTED FOR PRE~
/" "
<--~--
--------------------------------------------------------------------.-----------------
The above assessment has been established pursuant to the Pasco County Ordinance
No. 89-07 and Resolution No. 89-197 as commended.
THE ASSESSMENT WILL BE CALCULATED AT THE TIME OF ISSUANCE OF THE C/O. NO CERTIFICATE
OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE ASSESSMENT HAS BEEN PAID.
APPLICANT HEREBY ACKNOWLEDGES RECEIPT OF THIS NOTICE AND THE REQUIREMENT OF ASSESSMENT
FEE PAYMENT PRIOR TO C/O OR FINp~ RELEASE.
DATE
RECEIVED BY
--------------------------------------------------------------------------------------
FOR OFFICE USE ONLY
RECEIPT II
I ~1 L~ C. )
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J.. It) ~
DATE
BY
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